Human factors and institutional culture are key to ensuring safety in health care. The purpose of this study is to investigate organizational climate for nursing practice as a predictor of patient and nurse safety problems using existing anonymized patient and nurse data from all of the hospitals in Pennsylvania in 1999. The working hypothesis is that higher levels of resource adequacy, physician-nurse relations, and administrative support for nursing practice will be associated with lower levels of adverse outcomes for patients (in the form of potentially-preventable complications of care) and nurses (in the form of needlestick injuries). The proposed study will also examine protocols for deriving a number of quality indicators other than risk-adjusted mortality using patient discharge abstracts and study the interrelationships of these indices, including complication measures developed by the Agency for healthcare Research and Quality and the American Nurses' Association and a measure called failure to rescue. The research and training plans will be carried out at the Center for Health Outcomes and Policy research at the University of Pennsylvania, a leading research group, under the mentorship of internationally-recognized experts in nursing outcomes research involving organizational features. My goals for this Research Career Award are to: (1) gain expertise in the construction of patient outcome measures relevant to nursing practice from large administrative datasets; (2) develop an ability to use statistical methods and computer applications necessary for doing large-scale patient outcomes studies examining organization context; (3) conduct the proposed study; (4) gain further experience in planning and managing large-scale primary data collections; (5) disseminate the results of the proposed study in peer-reviewed forums; and to, (6) develop and submit investigator-initiated proposals to extend this work.